Publications by authors named "Ekram W Abd El-Wahab"

27 Publications

  • Page 1 of 1

Validation of a COVID-19 self-assessment tool for the prediction of COVID-19 in a primary health care setting in Egypt.

Prim Health Care Res Dev 2021 11 25;22:e75. Epub 2021 Nov 25.

Department of Endemic and Infectious Diseases, Alexandria Fever Hospital, Alexandria, Egypt.

Background: As SARS-CoV-2 infection is sweeping the globe, early identification and timely management of infected patients will alleviate unmet health care demands and ultimately control of the disease. Remote COVID-19 self-assessment tools will offer a potential strategy for patient guidance on medical consultation versus home care without requiring direct attention from healthcare professionals.

Objective(s): This study aimed to assess the validity and interrater reliability of the initial and modified versions of a COVID-19 self-assessment prediction tool introduced by the Egyptian Ministry of Health and Population (MoHP) early in the epidemic. The scoring tool was released for the public through media outlets for remote self-assessment of SARS-CoV-2 infection connecting patients with the appropriate level of care.

Methods: We evaluated the initial score in the analysis of 818 consecutive cases presenting with symptoms suggesting COVID-19 in a single-primary health care clinic in Alexandria during the epidemic in Egypt (mid-February through July). Validity parameters, interrater agreement and accuracy of the score as a triage tool were calculated versus the COVID-19 polymerase chain reaction (PCR) test.

Results: A total of 818 patients reporting symptoms potentially attributable to COVID-19 were enrolled. The initial tool correctly identified 296 of 390 COVID-19 PCR +ve cases (sensitivity = 75.9%, specificity = 42.3%, positive predictive value = 54.5%, negative predictive value = 65.8%). The modified versions of the MoHP triage score yielded comparable results albeit with a better accuracy during the late epidemic phase. Recent history of travel [OR (95% CI) = 12.1 (5.0-29.4)] and being a health care worker [OR (95% CI) = 5.8 (2.8-11.9)] were major predictors of SARS-CoV-2 infection in early and late epidemic phases, respectively. On the other hand, direct contact with a respiratory infection case increased the risk of infection by three folds throughout the epidemic period.

Conclusion: The tested score has a sufficient predictive value and potential as a triage tool in primary health care settings. Updated implementation of this home-grown tool will improve COVID-19 response at the primary health care level.
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http://dx.doi.org/10.1017/S1463423621000736DOI Listing
November 2021

Effectiveness of hepatitis B vaccination in chronic HCV patients after successful generic direct acting antiviral therapy: significance of isolated hepatitis B core antibodies.

Trop Med Int Health 2021 08 29;26(8):882-894. Epub 2021 Apr 29.

Department of Biostatistics, High Institute of Public Health, Alexandria University, Alexandria, Egypt.

Objective: Previous reports show conflicting results regarding hepatitis B virus (HBV) vaccine efficacy in Hepatitis C virus (HCV) infected individuals and in those with isolated hepatitis B core antibodies (HBcAb). We aimed to evaluate the effectiveness of HBV vaccine and identify possible factors that may contribute to hyporesponsivness in HCV-treated patients, including those with isolated HBcAb.

Methods: We conducted a prospective study with 118 enrolled chronic HCV patients who followed a 12-week regimen of direct acting antivirals (DAAs) and were evaluated for HBV serological markers. Eventually, 98 received appropriate HBV vaccination and were assessed for response.

Results: A total of 57.1% were vaccine responders although only 5.1% achieved a seroprotective level of HBsAb titre. The response rate was significantly lower among treated HCV patients with isolated HBcAb [2 (5.6%) vs. 40 (64.5%) respectively]. On multivariate analysis, advanced age [OR (95% CI) = 1.09 (1.02-1.17)] and presence of isolated HbcAb [OR (95% CI) = 39.59 (7.98-196.63)] were predictors of vaccine non-response. In our cost-effectiveness models, the cost of HBV serological screening was less than the nationally adopted non-screening approach. A model ratifying reinforced vaccination in non-responder HBcAb seropositive HCV patients would incur extra cost.

Conclusion: Hyporesponsiveness to the HBV vaccination is frequent in chronic HCV patients even after achieving SVR following DAAs. Although there is no consensus on the clinical management of patients with isolated HBcAb, our cost-effectiveness options may support decision-making for better clinical benefit and proper health investments.
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http://dx.doi.org/10.1111/tmi.13588DOI Listing
August 2021

Identifying factors increasing the risk of acquiring HIV among Egyptians to construct a consensus web-based tool for HIV risk assessment.

Curr Med Res Opin 2021 06 27;37(6):973-984. Epub 2021 Mar 27.

Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt.

Background: Accurate information on HIV transmission risk is required to construct evidence-based risk reduction practices for individuals and to direct the provision of prevention strategies at the population level. HIV transmission risk assessment will help in identifying individuals at high risk of HIV infection and directing the provision of post exposure prophylaxis (PEP).

Objective: To identify the common risk factors for HIV transmission in the Egyptian community in order to construct a web-based HIV risk assessment tool.

Methods: Following a systematic review and meta-analysis of published literature on HIV transmission and risk factors, we retrieved the key determinants of HIV exposure risk. In parallel, we conducted a case control study to identify the common risk factors for HIV transmission in the Egyptian community. The identified risk factors were incorporated in weighted risk scoring models to allow the quantification of the risk of HIV acquisition.

Results: There were 38 determinants associated with HIV seropositivity [people living with HIV (PLWH)] among Egyptians compared to 34 risk factors identified in our meta-analysis. All the derived scores showed high accuracy for predicting HIV infection status [sensitivity, specificity, PPV and NPV of greater than 90.0%, (AUC = 0.998-1.000;  < .001)].

Conclusion: Key drivers of HIV transmissions can be incorporated into a risk scoring model in order to quantify the risks of HIV acquisition. Such tools can facilitate the screening of PLWH and at-risk-individuals and direct interventions to halt HIV transmission.
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http://dx.doi.org/10.1080/03007995.2021.1901678DOI Listing
June 2021

How accurate is the diagnosis of rheumatic fever in Egypt? Data from the national rheumatic heart disease prevention and control program (2006-2018).

PLoS Negl Trop Dis 2020 08 17;14(8):e0008558. Epub 2020 Aug 17.

Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt.

Rheumatic heart disease (RHD) as a chronic sequela of repeated episodes of acute rheumatic fever (ARF), remains a cause of cardiac morbidity in Egypt although it is given full attention through a national RHD prevention and control program. The present report reviews our experience with subjects presenting with ARF or its sequelae in a single RHD centre and describes the disease pattern over the last decade. A cross-sectional study was conducted in El-Mahalla RHD centre between 2006 and 2018. A total of 17014 individual were enrolled and evaluated. Diagnosis ARF was based on the 2015 revised Jones criteria and RHD was ruled in by echocardiography. The majority of the screened subjects were female (63.2%), in the age group 5-15 years (64.6%), rural residents (61.2%), had primary education (43.0%), and of low socioeconomic standard (50.2%). The total percentage of cases presenting with ARF sequelae was 29.3% [carditis/RHD (10.8%), rheumatic arthritis (Rh.A) (14.9%), and Sydenham's chorea (0.05%)]. Noticeably, 72% were free of any cardiac insult, of which 37.7% were victims of misdiagnoses made elsewhere by untrained practitioners who prescribed for them long term injectable long-acting penicillin [Benzathine Penicillin G (BPG)] without need. About 54% of the study cohort reported the occurrence of recurrent attacks of tonsillitis of which 65.2% underwent tonsillectomy. Among those who experienced tonsillectomy and/or received BPG in the past, 14.5% and 22.3% respectively had eventually developed RHD. Screening of family members of some RHD cases who needed cardiac surgery revealed 20.7% with undiagnosed ARF sequalae [RHD (56.0%) and Rh.A (52.2%)]. Upon the follow-up of RHD cases, 1.2% had improved, 98.4% were stable and 0.4% had their heart condition deteriorated. Misdiagnosis of ARF or its sequelae and poor compliance with BPG use may affect efforts being exerted to curtail the disease. Updating national guidelines, capacity building, and reliance on appropriate investigations should be emphasized. Since the genetic basis of RHD is literally confirmed, a family history of RHD warrants screening of all family members for early detection of the disease.
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http://dx.doi.org/10.1371/journal.pntd.0008558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451991PMC
August 2020

Spatio-temporal Distribution of Meningitis in HIV Patients in Northern Egypt (2000-2018).

Curr HIV Res 2020 ;18(6):405-414

Department of Endemic and Infectious Diseases, Alexandria Fever Hospital, Alexandria, Egypt

Background: Meningitis is a leading cause of death among patients living with HIV. There is no adequate tracking of the disease occurrence, distribution and etiologic agents among this risk group in Egypt, although the pattern could differ from that of the general population.

Objectives: We aimed to describe the spatio-temporal distribution of meningitis in HIV patients in a region of Northern Egypt over 18 years (2000-2018).

Methods: We conducted a retrospective study of 352 adult HIV patients admitted to a tertiary care fever hospital with neurological manifestations suggesting meningitis. We retrieved from inpatient records all data relevant to patient demographics, clinical presentation, diagnostic work-up, results of laboratory investigations (CSF, blood, imaging), definitive diagnosis, and in-hospital mortality.

Results: The overall trend of over 2 decades showed fluctuating incidence of meningitis in HIV infected patients and increasing spread into rural areas, with a uniform circulation among adult males. Cryptococcal meningitis was the most common etiologic agent (26.9%) and was associated with worse outcomes. Focal neurological deficit (38.5%), cranial nerve involvement (48.1%) were common features in TB Meningitis. The mortality was high (56.8%) and was significantly associated with low CD4+ count, advanced AIDs clinical stage and the presence of co-morbidities.

Conclusion: Despite the availability of cART, meningitis, particularly cryptococcal, is common in HIV/AIDS population in Egypt. Continued efforts are desperately needed to improve the outcomes of HIV-infected patients.
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http://dx.doi.org/10.2174/1570162X18666200810132605DOI Listing
October 2021

Validation of a Non-Laboratory Based Screening Tool for Predicting Non-Alcoholic Fatty Liver Disease in an Egyptian Setting.

Am J Med Sci 2020 12 21;360(6):662-677. Epub 2020 Jun 21.

Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.

Background: Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disorder in more than 20% of the general population worldwide.  Several combinations of non-invasive factors and scoring models were investigated as indicators of NAFLD. This study aimed to validate and adapt an established fatty liver score, which allows the identification of NAFLD based on routinely available clinical and laboratory data.

Materials And Methods: The study cohort comprised 190 adults seeking health check-up at the out-patient clinic of a tertiary care hospital in Alexandria, Egypt. Anthropometric, clinical, and laboratory data were recorded and the status of fatty liver was diagnosed by abdominal ultrasound. A logistic regression model was built to determine the predictors of NAFLD. The performance of the derived risk scores was compared to other existing models.

Results: Obesity (60.0%), metabolic syndrome (42.6%), and NAFLD (56.8%) were predominant features among the study population. Smoking [OR (95% CI) = 4.4 (0.9-21.4)], obesity [OR (95% CI) = 4.0 (1.7-9.7)], hypertension [OR (95% CI) = 2.4 (1.03-5.5)], elevated serum total cholesterol [OR (95% CI) = 4.8 (1.8-13.1)], triglycerides [OR (95% CI) = 11.8 (2.3-661.02)], and ALT [OR (95% CI) = 4.8 (1.8-13.1)] were multivariate predictors of NAFLD. A NAFLD screening questionnaire with values applicable for Egyptians was adapted from an existing model after validation. A total score ≥7 was suggestive of NAFLD [AUC = 0.810 (0.749-0.871); sensitivity = 87.0%; specificity = 62.2%; PPV = 75.2%; NPV = 78.5%].

Conclusions: NAFLD can be sufficiently predicted among apparently healthy Egyptians by a tempted simple and non-invasive scoring index although external validation is warranted.
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http://dx.doi.org/10.1016/j.amjms.2020.06.020DOI Listing
December 2020

Attributes of HIV infection over decades (1982-2018): A systematic review and meta-analysis.

Transbound Emerg Dis 2020 Nov 22;67(6):2372-2388. Epub 2020 May 22.

Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt.

Understanding the risk factors for HIV infection is the foundation of successful preventive strategies, which must bundle sociocultural, behavioural and biomedical interventions to halt disease transmission. We aimed in this study to provide a pooled estimation of HIV risk factors and trace changes across decades in order to drive consensus and accurate assessment of disease transmission risk. We comprehensively searched PubMed, ISI Web of Knowledge, Medline, EMBASE, ScienceDirect, Ovid, EBSCO, Google Scholar and the Egyptian Universities Library Consortium from October to December 2018. Two independent reviewers extracted data from eligible studies. Funnel plots were inspected to identify publication bias. Heterogeneity across studies was checked using the Q and I statistics. The results were reported based on the pooled odds ratio (pOR) with 95% CI using a random-effects model. Meta-analysis of HIV risk factors revealed a superior role for risky sexual practices (unprotected vaginal/anal sex), injecting drug use (IDU), sharing needles, sexually transmitted infections (STIs), child sexual abuse and vertical transmissions. Trends across decades (1982-1999 and 2000-2018, respectively) showed rising evidence for prostitution [pOR (95% CI)= 2.3 (1.12-4.68) versus 2.69 (1.67-4.32)] and men who have sex with men (MSM) [pOR (95% CI)= 2.28 (1.64-3.17) versus 3.67 (1.88-7.17)], while transmission through IDU [pOR (95% CI)= 3.42 (2.28-5.12) versus 2.16 (1.74-2.70)], alcoholism [pOR (95% CI)= 2.35 (0.73-7.59) versus 1.71(1.08-2.72)], and sharing syringes [pOR (95% CI)= 6.10 (2.57-14.5) versus 2.70 (2.01-6.35)] showed notable decline. Harm reduction programs and condom use have been recognized as chief HIV prevention strategies, while male circumcision contributed a partial role. Collectively, sexual risk factors continue to be a key driver of the global HIV epidemic. Persistent and emerging risk factors identified in our analysis should constitute the forefront targets of HIV prevention programmes to accelerate efforts towards HIV elimination.
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http://dx.doi.org/10.1111/tbed.13621DOI Listing
November 2020

Assessment of oxidative stress among refueling workers in an Egyptian setting.

Environ Sci Pollut Res Int 2020 May 13;27(15):18099-18108. Epub 2020 Mar 13.

Department of Occupational Health and Air Pollution (Division of Occupational Hygiene and Air Pollution), High Institute of Public Health, Alexandria University, Alexandria, Egypt.

Background: Unlike developing countries, in Egypt, gasoline is dispensed at dedicated stations by gasoline filling workers. This leads to high levels of exposure to the aromatic compounds in gasoline [principally benzene, toluene, ethyl benzene, and xylene (BTEX)] with the consequences of adverse health effects including oxidative stress.

Objective(s): To assess oxidative stress and trace metal levels among Egyptian gas filling workers.

Methods: A cross-sectional study was conducted among 50 gasoline filling station workers (exposed group) and a matched group of 50 clerical workers (non-exposed group). Trace metal levels (Cu, Zn, Fe, and Mn) and the activities of the antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx) were measured in sera of all enrolled participants using atomic absorption spectroscopy. BTEX levels were assessed in the environment of the studied gas filling stations using the MIRAN IR system.

Results: All the measured trace metal levels and antioxidant enzyme activities were significantly lower among the exposed workers than among the non-exposed workers. All trace metals decreased significantly in relation to SOD activity among the exposed workers, whereas only Zn and Cu decreased in relation to SOD and GPx activity among the non-exposed workers. The exposed workers did not comply with the use of the required personal protective equipment (PPE) to avoid the dangerous effects of BTEX exposure. Among BTEX components, benzene exceeded the allowable Egyptian TLV in the studied gasoline stations (110.4 mg/m3 versus 1.6 mg/m3, respectively). The hygienic effect (HE) of the BTEX pollutant mixture exceeded the allowed borderline HE in Egypt although it did not show a significant correlation with different oxidative stress biomarkers and trace metals.

Conclusion: Exposure to BTEX at gasoline filling stations lowers the levels of antioxidant enzyme activities and trace metals due to the strong hygienic effect of BTEX. Individual protection using the proper PPE should therefore be enforced. Research assessing the need of providing refueling workers with supplements of necessary trace metals and antioxidants is warranted.
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http://dx.doi.org/10.1007/s11356-020-08359-2DOI Listing
May 2020

A clinical rule for the prediction of meningitis in HIV patients in the era of combination antiretroviral therapy.

Trans R Soc Trop Med Hyg 2020 04;114(4):264-275

Department of Endemic and Infectious Diseases, Alexandria Fever Hospital, 21568 Alexandria, Egypt.

Background: The diagnosis of meningitis in HIV patients is challenging due to altered immune responses. Diagnostic scoring systems were recently proposed for use in research settings to help prompt and easy differential diagnosis. The objective of this study was to create a clinical prediction rule (CPR) for meningitis in HIV-infected patients and to address the enigma of differentiating bacterial (BM), TB (TBM) and cryptococcal (CCM) meningitis based on clinical features alone, which may be enhanced by easy-to-obtain laboratory testing.

Methods: We retrospectively enrolled 352 HIV patients presenting with neurological manifestations suggesting meningitis over the last 18 y (2000-2018). Relevant clinical and laboratory information were retrieved from inpatient records. The features independently predicting meningitis or its different types in microbiologically proven meningitis cases were modelled by multivariate logistic regression to create a CPR in an exploratory data set. The performance of the meningitis diagnostic score was assessed and validated in a subset of retrospective data.

Results: AIDS clinical stage, injecting drug use, jaundice and cryptococcal antigen seropositivity were equally important as classic meningitic symptoms in predicting meningitis. Arthralgia and elevated cerebrospinal fluid Lactate dehydrogenase (LDH) were strong predictors of BM. Patients with cryptococcal antigenemia had 25 times the probability of having CCM, whereas neurological deficits were highly suggestive of TBM.

Conclusion: The proposed CPRs have good diagnostic potential and would support decision-making in resource-poor settings.
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http://dx.doi.org/10.1093/trstmh/trz107DOI Listing
April 2020

Sofosbuvir-/Daclatasvir-based therapy for chronic HCV and HCV/hepatitis B virus coinfected patients in Egypt.

Trans R Soc Trop Med Hyg 2020 02;114(3):200-212

Tropical Health Department, High Institute of Public Health, Alexandria University, 165 El Horreya Road, 21561 Alexandria, Egypt.

Background: Dramatic advances in hepatitis C virus (HCV) treatment were witnessed with the introduction of direct-acting antivirals (DAAs). Generic DAAs with remarkable efficacy and good safety profiles are currently manufactured by local pharmaceutical companies in Egypt.

Methods: In the real-world setting, of a total of 367 patients chronically infected with HCV, 289 (277 treatment-naïve and 12 treatment-experienced) patients were enrolled. Approximately 15% of the patients were coinfected with hepatitis B virus (HBV). Patients were treated with sofosbuvir+daclatasvir with or without ribavirin for 12 or 24 wk as the standard of care. HBV DNA levels were monitored throughout the study.

Results: A sustained virologic response at 12 wk (SVR12) was achieved in 98.3% of the patients. All non-responders were treatment-naïve and the response rate among treatment-experienced patients was 100.0%. Elevated α-fetoprotein and treatment with sofosbuvir+daclatasvir+ribavirin for 6 mo were predictors of non-response (OR [95% CI] = 1.06 [1.02 to 1.1] and 15.9 [1.8 to 136.2]; p<0.05, respectively). No HBV reactivation was noticed throughout the treatment and follow-up periods in HCV/HBV coinfected patients.

Conclusion: The present real-world findings add to the evidence for the efficacy of generic DAAs for the treatment of patients infected with HCV. HBV reactivation is unlikely to occur in those coinfected with HBV. Although liver cirrhosis affected the outcome, pretreatment liver chemistry did not seem to correlate with the results of treatment.
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http://dx.doi.org/10.1093/trstmh/trz079DOI Listing
February 2020

Adapting a Prediction Rule for Metabolic Syndrome Risk Assessment Suitable for Developing Countries.

J Prim Care Community Health 2019 Jan-Dec;10:2150132719882760

Department of Occupational Health and Air Pollution (Division of Occupational Health and Industrial Medicine), High Institute of Public Health, Alexandria University, Egypt.

Metabolic syndrome (MetS) is a cluster of cardiometabolic disturbances that increases the risk of cardiovascular diseases (CVD) and type 2 diabetes mellitus (DM). The early identification of high-risk individuals is the key for halting these conditions. The world is facing a growing epidemic MetS although the magnitude in Egypt is unknown. To describe MetS and its determinants among apparently healthy individuals residing in urban and rural communities in Egypt and to establish a model for MetS prediction. A cross-sectional study was conducted with 270 adults from rural and urban districts in Alexandria, Egypt. Participants were clinically evaluated and interviewed for sociodemographic and lifestyle factors and dietary habits. MetS was defined according to the harmonized criteria set by the AHA/NHLBI. The risk of ischemic heart diseases (IHDs), DM and fatty liver were assessed using validated risk prediction charts. A multiple risk model for predicting MetS was developed, and its performance was compared. In total, 57.8% of the study population met the criteria for MetS and were at high risk for developing IHD, DM, and fatty liver. Silent CVD risk factors were identified in 20.4% of the participants. In our proposed multivariate logistic regression model, the predictors of MetS were obesity [OR (95% CI) = 16.3 (6.03-44.0)], morbid obesity [OR (95% CI) = 21.7 (5.3-88.0)], not working [OR (95% CI) = 2.05 (1.1-3.8)], and having a family history of chronic diseases [OR (95% CI) = 4.38 (2.23-8.61)]. Consumption of caffeine once per week protected against MetS by 27.8-fold. The derived prediction rule was accurate in predicting MetS, fatty liver, high risk of DM, and, to a lesser extent, a 10-year lifetime risk of IHD. Central obesity and sedentary lifestyles are accountable for the rising rates of MetS in our society. Interventions are needed to minimize the potential predisposition of the Egyptian population to cardiometabolic diseases.
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http://dx.doi.org/10.1177/2150132719882760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822183PMC
June 2020

Multidomain Convergence of Argonaute during RISC Assembly Correlates with the Formation of Internal Water Clusters.

Mol Cell 2019 08 16;75(4):725-740.e6. Epub 2019 Jul 16.

Department of Chemistry and Biochemistry, The Ohio State University, Columbus, OH 43210, USA; Center for RNA Biology, The Ohio State University, Columbus, OH 43210, USA; Ohio State Biochemistry Program, The Ohio State University, Columbus, OH 43210, USA. Electronic address:

Despite the relevance of Argonaute proteins in RNA silencing, little is known about the structural steps of small RNA loading to form RNA-induced silencing complexes (RISCs). We report the 1.9 Å crystal structure of human Argonaute4 with guide RNA. Comparison with the previously determined apo structure of Neurospora crassa QDE2 revealed that the PIWI domain has two subdomains. Binding of guide RNA fastens the subdomains, thereby rearranging the active-site residues and increasing the affinity for TNRC6 proteins. We also identified two water pockets beneath the nucleic acid-binding channel that appeared to stabilize the mature RISC. Indeed, mutating the water-pocket residues of Argonaute2 and Argonaute4 compromised RISC assembly. Simulations predict that internal water molecules are exchangeable with the bulk solvent but always occupy specific positions at the domain interfaces. These results suggest that after guide RNA-driven conformational changes, water-mediated hydrogen-bonding networks tie together the converged domains to complete the functional RISC structure.
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http://dx.doi.org/10.1016/j.molcel.2019.06.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707842PMC
August 2019

A multifaceted risk model of brucellosis at the human-animal interface in Egypt.

Transbound Emerg Dis 2019 Nov 5;66(6):2383-2401. Epub 2019 Aug 5.

Zoonoses and Public Health Group, Kafrelsheikh University, Kafrelsheikh, Egypt.

Brucellosis is a highly contagious zoonosis affecting humans and a wide range of domesticated and wild animal species. An important element for effective disease containment is to improve knowledge, attitudes and practices (KAP) of afflicted communities. This study aimed to assess the KAP related to brucellosis at the human-animal interface in an endemic area of Egypt and to identify the risk factors for human infection. A matched case-control study was conducted at the central fever hospitals located in six governorates in northern Egypt. Face-to-face interviews with cases and controls were conducted using a structured questionnaire. In total, 40.7% of the participants owned farm animals in their households. The overall mean practice score regarding animal husbandry, processing and consumption of milk and dairy products were significantly lower among cases compared with controls (-12.7 ± 18.1 vs. 0.68 ± 14.2, respectively; p < .001). Perceived barriers for notification of animal infection/abortion were predominate among cases and positively correlated with participants' education. The predictors of having brucellosis infection were consumption of unpasteurized milk or raw dairy products and practicing animal husbandry. Applying protective measures against infection significantly reduced its risk. A model predicting risk factors for brucellosis among those who own animal showed that frequent abortions per animal increased the chance for brucellosis infection among human cases by 50-fold (95% CI: 8.8-276.9), whereas the use of protective measures in animal care reduced the odds (OR = 0.11 [95% CI: 0.03-0.45]). In conclusion, consumption of unprocessed dairy products was equally important as contact with infected/aborted animals as major risk factors for Brucella spp. infection among humans in Egypt. There is poor knowledge, negative attitudes and risky behaviours among villagers which can perpetuate the risk of brucellosis transmission at the human-animal interface. This supports the need for integrating health education into the national brucellosis control programme.
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http://dx.doi.org/10.1111/tbed.13295DOI Listing
November 2019

Seroprevalence of HBV among Egyptian municipal solid waste workers.

Heliyon 2019 Jun 17;5(6):e01873. Epub 2019 Jun 17.

Tropical Health Department (Parasitology and medical entomology specialty), High Institute of Public Health, Alexandria University, Egypt.

Background: Municipal solid waste workers (MSWWs) are potentially exposed to diverse hazards that are not merely a consequence of their occupation. Of particular concern are infectious diseases. The endemicity of hepatitis B virus (HBV) infection in Egypt suggests the possibility of disease transmission in MSWWs from improperly disposed hazardous materials found in the solid waste stream. To date, such transmission has not adequately been epidemiologically studied in Egypt.

Objective: To explore the seroprevalence of HBV among MSWWs in Egypt.

Methods: We conducted a descriptive cross-sectional study that included 1467 MSWWs recruited from the main municipality company in Alexandria, Egypt, in February 2018. The enrolled participants were categorized into two occupational groups (exposed; n = 1361 and non-exposed; n = 115) on the basis of their direct exposure to solid waste. The study procedure involved interviews using a predesigned questionnaire that covered general demographic information. Blood samples from all participants were tested for the hepatitis B surface antigen (HBsAg), a marker of active HBV infection, using a third-generation enzyme linked immunosorbent assay (ELISA).

Results: All MSWWs were male and had a mean age of 39.8 (±7.9) years. The majority were urban residents (72.8%) and engaged in solid waste collection (63.8%) or sorting (13.6%). The overall seroprevalence of active HBV infection was 1.5%. In total, 3.8% of the workers received the compulsory HBV vaccine during their infancy, meaning approximately 96.2% of the participants were at risk for HBV infection. Evaluating the availability and use of personal protective equipment revealed that most of the workers were provided with and wore overalls but not safety shoes, protective gloves, face masks, or helmets.

Conclusion: The present work suggests the possible transmission of HBV in workers exposed to municipal solid waste. This result necessitates the initiation of prophylactic HBV immunizations and the consideration of safer techniques for waste management.
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http://dx.doi.org/10.1016/j.heliyon.2019.e01873DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584845PMC
June 2019

Asthma action plan for proactive bronchial asthma self-management in adults: a randomized controlled trial.

Int Health 2018 11;10(6):502-516

General Director of the General Administration of Alexandria University Health Care Units, Alexandria, Egypt.

Background: Written personalized asthma action plans are recommended as part of patient education and self-management.

Objectives: To enable asthmatic adults to proactively self-manage bronchial asthma and sustain asthma quiescent status through utilization of the Asthma Action Plan (AAP), and to establish a feasible asthmatic/care taker-health care provider communication.

Design: Randomized controlled trial with cluster sampling by pulmonologists.

Setting And Participants: The study comprised 320 chronic asthmatic patients attending the chest department at the main health insurance hospital in Alexandria that were randomly allocated as the intervention group (AAIG; n=160) that received standard care and intervention by the AAP and a control group (AACG; n=160) that received the routine standard of care. Data were collected through an interviewing questionnaire. The study continued over a 6-month period and passed into three phase stations. During the preparatory phase the health care provider managed to explain, fill and simplify the use of the Arabic version of the AAP, to explain the correct utilization of the weekly follow-up form and to emphasize the weekly communication/visit with the health care provider (HCP) to update their weekly follow-up records. Follow-up was done on the 90th and 180th days from the launch of the study, respectively. The study asthmatics were subjected to history-taking of their asthma symptoms, signs and triggers, and a review of their medical/peak expiratory flow records, as well as his/her daily activity and exercise.

Results: The AAIG experienced superiority of the average of the green zone days ('doing well') with significantly more episodes of early asthma flare-up self-management concomitant with prominent fewer emergency department visits, hospitalization, admission at the ICU, private health facility, and days of sickness leaves and absenteeism. A preponderance of the high and medium adherence levels to asthma medications, avoidance of asthma triggers and smoking was achieved by the AAIG.

Conclusions: AAP was the basis for effective patient-health care provider communication and patient real time asthma flare-up self-management to achieve and sustain better asthma control in asthmatic adults.
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http://dx.doi.org/10.1093/inthealth/ihy050DOI Listing
November 2018

Real-life results of sofosbuvir based therapy in chronic hepatitis C -naïve and -experienced patients in Egypt.

PLoS One 2017 5;12(10):e0184654. Epub 2017 Oct 5.

Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.

Background: More than ten million Egyptians are infected with HCV. Every one of them is going to infect about three to four persons every year. Treating those patients is a matter of national security. A dramatic improvement in hepatitis C virus (HCV) infection treatment was achieved in the last five years. A new era of direct-acting antivirals is now dawning in Egypt.

Objective(s): We share in this report our clinical experience in treating chronic HCV Egyptian patients with Sofosbuvir based regimens to evaluate its safety and efficacy on real life practical ground.

Methods: A total of 205 chronic HCV patients (195 naive and 15 experienced) were enrolled in the study. Patient were treated with Sofosbuvir+Ribavirin 24 weeks as standard of care. Two interferon eligible patients were treated with PEG-INF+ Sofosbuvir+Ribavirin for 12 weeks. The primary efficacy endpoint was the proportion of patients with sustained virologic response at 24 weeks after cessation of therapy.

Results: The overall response rate was 97.1%. Sustained virological response rate did not differ among treatment-naive patients and patients with previous history of IFN-based therapy. Portal hypertension, prediabetes, and lack of early virologic response were predictors of non response. No clinically significant treatment-emergent adverse effects were noted. No treatment discontinuation was encountered.

Conclusion: In the real-life setting, Sofosbuvir based regimens for 24 weeks has established an efficacious and well tolerated treatment in naïve and experienced patients with chronic HCV genotype 4 infection; although shorter treatment durations may be possible. However, patient follow up should extent to at least 6 months post-treatment and verifying viral load on yearly basis is warranted to track any late relapse.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0184654PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628811PMC
October 2017

Risky exposures and national estimate of HCV seroprevalence among school children in urban Egypt.

Virusdisease 2016 Dec 12;27(4):351-356. Epub 2016 Sep 12.

Department of Tropical Health, High Institute of Public Health, Alexandria University, 165 El Horreya Road, Alexandria, 21561 Egypt.

Hepatitis C virus (HCV) is a significant cause of morbidity and mortality all over the world, particularly in Egypt. Limited data are available concerning the national seroprevalence and the possible modes of transmission of HCV in the pediatric age group. The aim of this study was to obtain a better estimate of the national hepatitis C seroprevalence and the possible risky exposures among healthy school children in Alexandria; the second biggest city in Egypt. HCV knowledge and counseling for school children were also investigated. A total of 500 school children, age between 6 and 15 years were evaluated for HCV seropositivity and interviewed for potential disease risk factors. The seropositivity for Anti-HCV Ab was 2.8 %. About 71.4 % of seropositive children were 10-15 years old. Urban residence, chronic disease, male circumcision and invasive procedures were detected as significant risk factors for acquiring HCV infection among the studied children. The level of awareness of hepatitis C among school children was very low (3.6 %) and was correlated with the age and educational level. HCV infection continues to occur in children and is frequently unrecognized. This mandates immediate intervention and robust control strategies in the settings of exposure combined with health education programs to limit further HCV spread.
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http://dx.doi.org/10.1007/s13337-016-0345-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142596PMC
December 2016

HIV-1 Pr55 binds genomic and spliced RNAs with different affinity and stoichiometry.

RNA Biol 2017 01 14;14(1):90-103. Epub 2016 Nov 14.

a Université de Strasbourg, CNRS, Architecture et Réactivité de l'ARN , Strasbourg , France.

The HIV-1 Pr55 precursor specifically selects genomic RNA (gRNA) from a large variety of cellular and spliced viral RNAs (svRNAs), however the molecular mechanisms of this selective recognition remains poorly understood. To gain better understanding of this process, we analyzed the interactions between Pr55 and a large panel of viral RNA (vRNA) fragments encompassing the main packaging signal (Psi) and its flanking regions by fluorescence spectroscopy. We showed that the gRNA harbors a high affinity binding site which is absent from svRNA species, suggesting that this site might be crucial for selecting the HIV-1 genome. Our stoichiometry analysis of protein/RNA complexes revealed that few copies of Pr55 specifically associate with the 5' region of the gRNA. Besides, we found that gRNA dimerization significantly impacts Pr55 binding, and we confirmed that the internal loop of stem-loop 1 (SL1) in Psi is crucial for specific interaction with Pr55. Our analysis of gRNA fragments of different length supports the existence of a long-range tertiary interaction involving sequences upstream and downstream of the Psi region. This long-range interaction might promote optimal exposure of SL1 for efficient Pr55 recognition. Altogether, our results shed light on the molecular mechanisms allowing the specific selection of gRNA by Pr55 among a variety of svRNAs, all harboring SL1 in their first common exon.
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http://dx.doi.org/10.1080/15476286.2016.1256533DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5270550PMC
January 2017

Toward a simple risk assessment screening tool for HCV infection in Egypt.

J Med Virol 2016 10 21;88(10):1767-75. Epub 2016 Mar 21.

Department of Tropical Health, High Institute of Public Health, Alexandria University, Egypt.

Asymptomatic patients with HCV infection identified through screening program could benefit not only from treatment but also from other interventions such as counseling to maintain health and avoid risk behaviors. This might prevent the spread of infection and result in significant public health benefits. However, mass screening would quickly deplete resources. This work aims to develop a brief HCV risk assessment questionnaire that inquires initially about a wide range of risk factors found to be potentially associated with HCV infection in order to identify the few most significant questions that could be quickly used to facilitate cost-effective HCV case-finding in the general population in Egypt. An exhaustive literature search was done to include all reported HCV risk factors that were pooled in a 65 item questionnaire. After an initial pilot study, a case-control study was performed that included 1,024 cases and 1,046 controls. In a multivariable model, a list of independent risk factors were found to be significant predictors for being HCV seropositive among two age strata (<45 and >45 years) for each gender. A simplified model that assigned values of the odds ratio as a weight for each factor present predicted HCV infection with high diagnostic accuracy. Attaining the defined cut-off value of the total risk score enhances the effectiveness of screening. HCV risk factors in the Egyptian population vary by age and gender. An accurate prediction screening tool can be used to identify those at high risk who may benefit most from HCV serologic testing. These results are to be further validated in a large scale cross-sectional study to assess the wider use of this tool. J. Med. Virol. 88:1767-1775, 2016. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/jmv.24520DOI Listing
October 2016

Clinico-epidemiological profile of fever of unknown origin in an Egyptian setting: A hospital-based study (2009-2010).

J Infect Dev Ctries 2016 Jan 31;10(1):30-42. Epub 2016 Jan 31.

High Institute of Public Health, Alexandria University, Egypt.

Introduction: Fever of unknown origin (FUO) is one of the most challenging diagnostic dilemmas in the field of infectious diseases and tropical medicine. Clinicians should use the frequency distribution of disorders causing FUO to guide their diagnostic approach in patients with prolonged, unexplained fevers meeting the definition of FUO.

Methodology: The present study was undertaken to examine the etiologies, clinico-epidemiologic profile, and prognosis of classical FUO in patients reporting to the Alexandria Fever Hospital in Egypt. Records of 979 patients admitted to the fever hospital (from January 2009 to January 2010) and diagnosed as having FUO were examined carefully. FUO was defined as three outpatient visits or three days in the hospital without elucidation of cause of fever.

Results: A total of 979 cases (57.0% males and 43.0% females), with ages ranging from 0.2 to 90 years, were investigated. The mean duration of fever before hospitalization was 31 ± 10 days. The etiology of FUO was delineated in 97% of cases, and only 3% remained undiagnosed. Diagnoses were grouped into five major categories. Infectious causes of FUO were strongly associated with better outcome (73.7% improved). Smoking, contact with animals or birds, drug addiction, and HIV seropositivity were important risk factors associated with infections.

Conclusions: Infections are the most common cause of FUO, followed by collagen vascular diseases, in our region. A three-step diagnostic work-up approach is recommended to be applied in Egypt in order to improve the quality of medical service provided to FUO patients.
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http://dx.doi.org/10.3855/jidc.7198DOI Listing
January 2016

Risk Factors Associated with Parasitic Infection Among Municipality Solid-Waste Workers in an Egyptian Community.

J Parasitol 2016 04 25;102(2):214-21. Epub 2015 Nov 25.

Tropical Health Department, High Institute of Public Health, Alexandria University, 165 El Horreya Road, 21561 Alexandria, Egypt.

Solid-waste management is associated with several health hazards, particularly parasitic infection. The objective of the study was to determine the association between risk factors and the occurrence of intestinal parasitic infections (potentially pathogenic) among municipal waste collectors in Alexandria, Egypt. A cross-sectional survey was conducted in the main municipality company in Alexandria. A total of 346 municipality solid-waste workers (MSWWs) was interviewed using an in-depth questionnaire. The type of parasitic infections among waste handlers was determined using formol-ether concentration and modified Ziehl-Neelsen technique. About half of the workers were infected with parasites. The profile of parasitic infection revealed 12 parasitic species. These were comprised of the following helminths: Schistosoma mansoni (13.3%), Enterobius vermicularis (1.7%), Ascaris lumbricoides (1.4%), and Hymenolepis nana ova (0.6%). Among protozoa were pathogenic Entamoeba histolytica (3.2%), Giardia intestinalis (2.9%), nonpathogenic protozoa such as Entamoeba coli (1.7%), and potentially pathogenic or opportunistic ones as Cryptosporidium (23.4%), Microsporidia (20.25%), Cyclospora (2.0%), Blastocystis hominis (1.7%), and Cystoisospora belli (1.2%). About 1.4% of MSWWs have pediculosis and phthiriasis in their scalp and eyelashes respectively. Risk factors for infection were associated with direct exposure to solid fecal waste (odds ratio [OR] = 1.8, confidence interval [CI] = 1.1-3.0) and occupational activities that allowed for direct exposure to solid fecal waste (OR = 2.3, CI = 1.4-4.0). Logistic regression model has revealed that educational level and residence were the factors that contribute to parasitic infection among MSWWs (P < 0.05). MSWWs are at high risk of acquiring parasitic infections. Data of the present study highlighted the need for greater biomonitoring of MSWWs and the improvement of environmental conditions and health care in such marginalized communities to prevent parasitic infection and associated morbidities.
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http://dx.doi.org/10.1645/15-782DOI Listing
April 2016

Fibrocytes Differ from Macrophages but Can Be Infected with HIV-1.

J Immunol 2015 Nov 28;195(9):4341-50. Epub 2015 Sep 28.

Center for AIDS Research, Kumamoto University, Kumamoto 860-0811, Japan; International Research Center for Medical Sciences, Kumamoto University, Kumamoto 860-0811, Japan;

Fibrocytes (fibroblastic leukocytes) are recently identified as unique hematopoietic cells with features of both macrophages and fibroblasts. Fibrocytes are known to contribute to the remodeling or fibrosis of various injured tissues. However, their role in viral infection is not fully understood. In this study, we show that differentiated fibrocytes are phenotypically distinguishable from macrophages but can be infected with HIV-1. Importantly, fibrocytes exhibited persistently infected cell-like phenotypes, the degree of which was more apparent than macrophages. The infected fibrocytes produced replication-competent HIV-1, but expressed HIV-1 mRNA at low levels and strongly resisted HIV-1-induced cell death, which enabled them to support an extremely long-term HIV-1 production at low but steady levels. More importantly, our results suggested that fibrocytes were susceptible to HIV-1 regardless of their differentiation state, in contrast to the fact that monocytes become susceptible to HIV-1 after the differentiation into macrophages. Our findings indicate that fibrocytes are the previously unreported HIV-1 host cells, and they suggest the importance of considering fibrocytes as one of the long-lived persistently infected cells for curing HIV-1.
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http://dx.doi.org/10.4049/jimmunol.1500955DOI Listing
November 2015

Factors Associated with Hepatitis C Infection among Chronic HCV Egyptian Patients.

Iran J Public Health 2014 Nov;43(11):1510-8

1. Dept. of Tropical Health, High Institute of Public Health, Alexandria University , Egypt.

Background: Identification of risk factors of acute hepatitis C virus (HCV) infection in Egypt is crucial for developing appropriate prevention strategies. There are few community-based studies on the epidemiology and risk factors of hepatitis C infection in Egypt, which could not provide enough information. Clear identification of past and current risk factors for infection is of utmost importance so that intervention programs can be appropriately focused. This study aims to provide up-to-date information about changes in the incidence of individual risk factors for HCV infection transmission in Egypt.

Methods: A total of 396 chronic HCV patients on follow-up treatment at liver center in El-Qabbary General Hospital in Alexandria were evaluated retrospectively regarding the potential iatrogenic, community acquired and behavioral HCV risk factors. Risk factors for HCV transmission were found in all study populations.

Results: At least three identifiable risk factors were reported by each participant. Some behavioral and community-acquired exposures that entail several risky behaviors particularly, unsafe sexual practices were exclusively established among males. We report a significant decline in prevalence of HCV transmission through blood transfusion, parenteral treatment, hospitalization, surgery, non medicalized circumcision, Hijiama done by informal practitioner, tattooing, folk body piercing and threading, sharing hygiene and sharp items, and the use of communal barber or manicure sets among younger age cluster.

Conclusion: The pattern of risk differed among older patients compared to younger age group suggesting improved medical care and infection control measures and raised public health awareness regarding the different modes of viral transmission.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449500PMC
November 2014

Insulin resistance as a predictor of early virologic response to HCV therapy among chronic HCV Egyptian patients.

J Med Virol 2015 Mar 12;87(3):428-40. Epub 2015 Jan 12.

Tropical Health Department, High Institute of Public Health, Alexandria University, Egypt.

Prior assessment of insulin resistance by HOMA-IR is emerging as an important milestone in the treatment of patients with chronic hepatitis C. This cost-effective tool is recommended to individualize treatment duration, or to exclude those with low insulin sensitivity from being treated until ameliorating their state of insulin resistance (IR). The present work aims to elucidate further the effect IR state on early viral kinetic response to Chronic hepatitis C virus (HCV) therapy and the impact of HCV treatment and viral eradication on insulin sensitivity. Insulin sensitivity was assessed using the HOMA-IR method. All enrolled patients were treated with a dual therapy (pegylated interferon-alpha plus ribavirin) for 48 weeks and evaluated using qRT-PCR for early virologic response as well as the impact of treatment on insulin sensitivity throughout the early period of therapy. Of a total 392 chronic HCV cases, early virologic response was achieved by 318 (81.1%). IR was detected in 241 (61.5%) chronic HCV patient of which 73.4% responded to treatment. Early virologic response among patients with > 2.18 HOMA-IR value were significantly lower than those with HOMA-IR values ≤2.18 (P < 0.0001). IR was significantly associated with high baseline BMI. Steatosis and fibrosis correlated with IR but neither independently predicted early virologic response. Pretreatment IR < 2.18, low fasting blood glucose, low and intermediate HCV viral load, normal BMI, and non-smoking were independent factors associated with early virologic response. IR interferes with early virologic response to the antiviral care. Clinical application of pretreatment HOMA-IR assessment could help in predicting early treatment outcome and thus enable treatment regimens to be optimized and individually tailored.
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http://dx.doi.org/10.1002/jmv.24092DOI Listing
March 2015

Specific recognition of the HIV-1 genomic RNA by the Gag precursor.

Nat Commun 2014 Jul 2;5:4304. Epub 2014 Jul 2.

Architecture et Réactivité de l'ARN, Université de Strasbourg, CNRS, IBMC, 15 rue René Descartes, 67084 Strasbourg, France.

During assembly of HIV-1 particles in infected cells, the viral Pr55(Gag) protein (or Gag precursor) must select the viral genomic RNA (gRNA) from a variety of cellular and viral spliced RNAs. However, there is no consensus on how Pr55(Gag) achieves this selection. Here, by using RNA binding and footprinting assays, we demonstrate that the primary Pr55(Gag) binding site on the gRNA consists of the internal loop and the lower part of stem-loop 1 (SL1), the upper part of which initiates gRNA dimerization. A double regulation ensures specific binding of Pr55(Gag) to the gRNA despite the fact that SL1 is also present in spliced viral RNAs. The region upstream of SL1, which is present in all HIV-1 RNAs, prevents binding to SL1, but this negative effect is counteracted by sequences downstream of SL4, which are unique to the gRNA.
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http://dx.doi.org/10.1038/ncomms5304DOI Listing
July 2014

Adverse health problems among municipality workers in alexandria (egypt).

Int J Prev Med 2014 May;5(5):545-56

Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt.

Background: Solid waste management has emerged as an important human and environmental health issue. Municipal solid waste workers (MSWWs) are potentially exposed to a variety of occupational biohazards and safety risks. The aim of this study was to describe health practices and safety measures adopted by workers in the main municipal company in Alexandria (Egypt) as well as the pattern of the encountered work related ill health.

Methods: A cross-sectional study was conducted between January and April 2013. We interviewed and evaluated 346 workers serving in about 15 different solid waste management activities regarding personal hygiene, the practice of security and health care measures and the impact of solid waste management.

Results: Poor personal hygiene and self-care, inadequate protective and safety measures for potentially hazardous exposure were described. Impact of solid waste management on health of MSWWs entailed high prevalence of gastrointestinal, respiratory, skin and musculoskeletal morbidities. Occurrence of accidents and needle stick injuries amounted to 46.5% and 32.7% respectively. The risk of work related health disorders was notably higher among workers directly exposed to solid waste when compared by a group of low exposure potential particularly for diarrhea (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.2-3.8), vomiting (OR = 2.7, 95% CI = 1.1-6.6), abdominal colic (OR = 1.9, 95% CI = 1.1-3.2), dysentery (OR = 3.6, 95% CI = 1.3-10), dyspepsia (OR = 1.8, 95% CI = 1.1-3), low back/sciatic pain (OR = 3.5, 95% CI = 1.8-7), tinnitus (OR = 6.2, 95% CI = 0.3-122) and needle stick injury (OR = 3.4, 95% CI = 2.1-5.5).

Conclusions: Workers exposed to solid waste exhibit significant increase in risk of ill health. Physician role and health education could be the key to assure the MSWWs health safety.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4050674PMC
May 2014

A comprehensive hepatitis C virus risk factors meta-analysis (1989-2013): do they differ in Egypt?

Liver Int 2015 Feb 8;35(2):489-501. Epub 2014 Jul 8.

Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.

Background & Aims: The prevention and control of HCV infection is complex and challenging in terms of describing risk factors and modes of transmission. This meta-analysis was conducted to summarize the best available data on HCV risk factors worldwide and in Egypt.

Methods: Through exhaustive literature searches (1989-2013) of HCV risk factors, 357 original eligible articles were included in this study.

Results: The highest detected risk was intravenous drug users (IDUs) (OR = 9.6) followed by HIV infection (OR = 4.9), having an IDU partner (OR = 4.1), HBV infection (OR = 3.5), Caesarean section (CS) (OR = 3.35), blood transfusion (OR = 3.2) and having an HCV+ partner (OR = 3). Organ transplantation, hospital admission, haemodialysis and having a sexually transmitted infection carry 2.96, 2.4, 2.18 and 2 risks of having HCV respectively. Other significant risk factors included poor education, older age, sharing sharp or blunt objects, MSM, tattooing, hijama, body piercing, minor operations and medical procedures. Some risks showed a decrease over the previous decade, including blood transfusion, organ transplantation, IDUs, IDU partner and CS. Others showed rising risks, including having an HCV+ partner, MSM and suffering from STI. In Egypt, male gender, rural residence, acupuncture and receiving parenteral antischistosomal treatment were significant risks, while neither HIV nor HBV were found to carry a risk of HCV infection.

Conclusion: Blood transfusion, organ transplantation, CS, IDUs, haemodialysis, minor operations and medical procedures are established risk factors. Attention and urgent intervention should be given to the sexual route of transmission, as well as that through minor operations and medical procedures.
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http://dx.doi.org/10.1111/liv.12617DOI Listing
February 2015
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